FCRs were the most-common rounding category among respondents. FCRs were not associated with a self-reported increase in rounding duration. Successful FCR implementation may require educating staff members and trainees about FCR benefits and addressing FCR barriers.

The use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists (henceforth referred to as “pediatric physicians”) has the potential to transform the practice of pediatrics. The purpose of this policy statement is to describe the expected and potential impact that telemedicine will have on pediatric physicians’ efforts to improve access and physician workforce shortages. The policy statement also describes how the American Academy of Pediatrics can advocate for its members and their patients to best use telemedicine technologies to improve access to care, provide more patient- and family-centered care, increase efficiencies in practice, enhance the quality of care, and address projected shortages in the clinical workforce. As the use of telemedicine increases, it is likely to impact health care access, quality, and education and costs of care. Telemedicine technologies, applied to the medical home and its collaborating providers, have the potential to improve current models of care by increasing communication among clinicians, resulting in more efficient, higher quality, and less expensive care. Such a model can serve as a platform for providing more continuous care, linking primary and specialty care to support management of the needs of complex patients. In addition, telemedicine technologies can be used to efficiently provide pediatric physicians working in remote locations with ongoing medical education, increasing their ability to care for more complex patients in their community, reducing the burdens of travel on patients and families, and supporting the medical home. On the other hand, telemedicine technologies used for episodic care by nonmedical home providers have the potential to disrupt continuity of care and to create redundancy and imprudent use of health care resources. Fragmentation should be avoided, and telemedicine, like all primary and specialty services, should be coordinated through the medical home.

Objective Family-centered bedside rounds (FCBR) are recommended to improve trainee education, patient outcomes, and family satisfaction. However, bedside teaching has waned in recent years, potentially leading to less teaching and more concern for trainees. We examined medical students’ concerns, teaching evaluations, and attitudes after experiencing FCBR during the pediatric clerkship. Methods Data are both cross-sectional and pre- and post-clerkship surveys for 113 (89%) of 127 students. Students reported frequencies of post-clerkship concerns (14 items) and teaching experiences (17 items), with five response options (1=never, 2=rarely, 3=occasionally, 4=usually, 5=always, dichotomized with “frequent” being usually or occasionally). Students reported pre- and post-clerkship attitudes for 4 items on a 7-point scale (1=strongly disagree, 7=strongly agree). Analyses included adjusted means or proportions. Results The most commonly endorsed concern was presenting information in a way that was understandable to patients and families with 34.5% of students having this concern frequently. The majority of students frequently experienced 12 of the 17 teaching items. Effective teaching of physical exam skills was the teaching item least often experienced frequently by students (20.3%). Student attitudes about the benefits of FCBR for families were significantly more positive post-clerkship (mean change 0.37 pts, p<0.001), but they remained neutral in their preference for FCBR over traditional rounds without the family present (mean change −0.14 pts, p>0.05). Conclusions Although students demonstrate positive attitudes toward FCBR and report frequent occurrence of inpatient teaching elements, findings suggest opportunities for easing student concerns and for using this venue to teach exam skills.

Purpose Factors that support self-efficacy must be understood in order to foster family-centered care (FCC) during rounds. Based on social cognitive theory, this study examined (1) how 3 supportive experiences (observing role models, having mastery experiences, and receiving feedback) influence self-efficacy with FCC during rounds and (2) whether the influence of these supportive experiences was mediated by self-efficacy with 3 key FCC tasks (relationship building, exchanging information, and decision making). Method Researchers surveyed 184 students during pediatric clerkship rotations during the 2008–2011 academic years. Surveys assessed supportive experiences and students’ self-efficacy with FCC during rounds and with key FCC tasks. Measurement models were constructed via exploratory and confirmatory factor analyses. Composite indicator structural equation (CISE) models evaluated whether supportive experiences influenced self-efficacy with FCC during rounds and whether self-efficacy with key FCC tasks mediated any such influences. Results Researchers obtained surveys from 172 eligible students who were 76% (130) White and 53% (91) female. Observing role models and having mastery experiences supported self-efficacy with FCC during rounds (each p<0.01), while receiving feedback did not. Self-efficacy with two specific FCC tasks, relationship building and decision making (each p < 0.05), mediated the effects of these two supportive experiences on self-efficacy with FCC during rounds. Conclusions Observing role models and having mastery experiences foster students’ self-efficacy with FCC during rounds, operating through self-efficacy with key FCC tasks. Results suggest the importance of helping students gain self-efficacy in key FCC tasks before the rounds experience and helping educators implement supportive experiences during rounds.